Thursday, May 23, 2013
Breast cancers in dogs
I was operating on some mastectomy cases with Dr Daniel recently. Older unspayed dogs with mammary tumours. It is hard for the owners as anaesthetic risks are high and who would want a dog to die on the operating table? So, the owners generally will not want any surgery when the breast tumours were detected as small nodules as in one case. 7 months later, one tumour had exploded and there was an emotional decision to get the exploding tumour removed.
I am scared of doing such old dog anaesthesias as deaths are always round the corner, due to old age and poor health as well as the presence of spreading breast cancer cells in the old dog's body. Possibly to the lungs. Owing to economic reasons, no lung X-rays are usually done before surgery as heartlanders frequently complain about the high veterinary cost of surgery. Prices keep going up as evident by the Car's COE prices having shot up today to over $65,000. At its lowest, it was $1.00. So you need another $65,000 on top of your car purchase price. Dr Daniel showed me a video clip of famous US actors e.g. Fast & Furious being asked about the prices of Singapore cars. They underestimated by over 50% when they compared to US car prices.
For heartlanders, it will be much cheaper to get the female dogs spayed when they are young as they seldom get breast cancers in old age. So less expenses and worries. But many don't do it and as a vet, we try to minimise costs but not to the extent of losing money. Young vets don't know how expensive it is to maintain a vet practice with the bureaucrats thinking of ways of adding costs like having to get an autoclave certified for safety every year. Why don't they get those gas cylinder valves in Singapore residences to be certified for safety yearly? There will be much unhappiness as this will add up the costs to the people.
I am scared of doing such old dog anaesthesias as deaths are always round the corner, due to old age and poor health as well as the presence of spreading breast cancer cells in the old dog's body. Possibly to the lungs. Owing to economic reasons, no lung X-rays are usually done before surgery as heartlanders frequently complain about the high veterinary cost of surgery. Prices keep going up as evident by the Car's COE prices having shot up today to over $65,000. At its lowest, it was $1.00. So you need another $65,000 on top of your car purchase price. Dr Daniel showed me a video clip of famous US actors e.g. Fast & Furious being asked about the prices of Singapore cars. They underestimated by over 50% when they compared to US car prices.
For heartlanders, it will be much cheaper to get the female dogs spayed when they are young as they seldom get breast cancers in old age. So less expenses and worries. But many don't do it and as a vet, we try to minimise costs but not to the extent of losing money. Young vets don't know how expensive it is to maintain a vet practice with the bureaucrats thinking of ways of adding costs like having to get an autoclave certified for safety every year. Why don't they get those gas cylinder valves in Singapore residences to be certified for safety yearly? There will be much unhappiness as this will add up the costs to the people.
1427. The runaway horse and other stories
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TOA
PAYOH VETS
Tuesday, May 21, 2013
Surgical cost of bladder stone removal surgery from two vets in 2 cases.
CASE1. Vet 1 quoted $1850 for removal of above bladder stones. The bladder is packed full. et 2
CASE 2. Vet 2 quoted $1,000 for removal of bladder stones. Both owners want payment by instalments but most times, the instalments don't get paid as the owners forget.
I had one couple who did not pay a cent for the Caesarean section of a Jack Russell some years ago. I did not get a deposit as I trusted them. So, nowadays, it is full payment at some clinics.
1425. New maid for Mrs Robinson
Yesterday, May 20, 2013, I visited Khin Khin's office. Her neighbour whose husband will not tolerate any man talking to her passed by with two tall glasses of water and came in to talk to her. One glass had 3 stalks of roses and the other was a leafed plant. "Don't call her Aunty," Khin Khin said. "Call her Ayi". I took over the glasses and put them on the table and smelled the roses.
"You don't smell the roses as these are for Buddha," Khin Khin said. "Now you have to pay $5.00 to buy replacement ones." The Ayi did not mind. All Buddhists offer flowers in front of the Buddha picture.
I noted a thin dark girl sitting quietly in the room. "Mrs Robinson's new maid had arrived," she said. As I was going back to the clinic, I offered to send her to Mrs Robinson's condo in Cairnhill Road, saving Khin Khin some time. "Mrs R is not in," she said to the new maid who had just arrived and carried a back pack and two plastic bags. One plastic bag had a frame of the Buddha. She showed me a photo of her parents. The father is 75 years old and is normal health in mind and body. The mother is 59 years old.
"Why don't you just work in Myanmar and be with your parents?" I asked her. She had worked in Singapore for a family in Bukit Panjang 3 years ago. "I can't save money," she had worked in a hotel in Yangon for around S$150 per month. Here, she would earn $500 with free board and lodging and would have some money to ha.
"You don't smell the roses as these are for Buddha," Khin Khin said. "Now you have to pay $5.00 to buy replacement ones." The Ayi did not mind. All Buddhists offer flowers in front of the Buddha picture.
I noted a thin dark girl sitting quietly in the room. "Mrs Robinson's new maid had arrived," she said. As I was going back to the clinic, I offered to send her to Mrs Robinson's condo in Cairnhill Road, saving Khin Khin some time. "Mrs R is not in," she said to the new maid who had just arrived and carried a back pack and two plastic bags. One plastic bag had a frame of the Buddha. She showed me a photo of her parents. The father is 75 years old and is normal health in mind and body. The mother is 59 years old.
"Why don't you just work in Myanmar and be with your parents?" I asked her. She had worked in Singapore for a family in Bukit Panjang 3 years ago. "I can't save money," she had worked in a hotel in Yangon for around S$150 per month. Here, she would earn $500 with free board and lodging and would have some money to ha.
1424. "Expiry date" of a Cocker Spaniel - to euthanase or not?
Case of euthanasia or not? May 20, 2013. 8 pm duty. Dr Sing Kong Yuen
THE CASE FOR OR AGAINST EUTHANASIA -
THE DOG HAS LIVED PAST THE EXPIRY DATE
14-year-old.male Cocker Spaniel.
Profuse salivation and "bad breath" now.
"He keeps drooling and he has bad breath. Is it worth treating him?" the gentleman owner consulted me for the first time at 7.30 pm on Monday May 20, 2013, half hour before my closing time. ""I read from the internet that Cocker Spaniels live up to 12 years and he is already 14 years old."
"This Cocker Spaniel is active. Is he eating or not?" I wanted to confirm.
"He eats a lot," the man said.
"One of the main reasons Singaporean dog owners put an old sick dog to sleep is financial," I said.
"Oh, I can afford the fees. Is it value for money? Will there be more medical problems down the road if you treat this drooling?"
"The decision to euthanase has to be made by the owner," I replied. "If he is my dog, I will get him treated for drooling and bad breath." Actually, there was no loud stench. I reviewed the medical records as the dog had been treated by my associate vets in the past 2 years. In April 2012, my associate vet had operated on the right ear for aural haematoma, excised a big skin wart and did dental scaling under anaesthesia. The costs amounted to $751. In May 2012, the dog was hospitalised 7 days for a ruptured skin abscess, costing $315. So, in 2012, the owner had spent around $1000 whereas for the past 11 years of the dog's life, he did not have to pay for veterinary costs except for the $35 annual vaccination from 2009 - 2012. In April 2013, he paid around $744 for dental and removal of skin lumps. Now there is profuse salivation.
So, I can understand that he is worried that there will be more veterinary bills and since the Cocker Spaniel is expected to live for 12 years, his dog had exceeded the life expectancy. So, he asked me whether he ought to euthanase him. The cost of living had shot up incredibly high with car, rental and property prices too high as there seemed to be a group of rich consumers. Many heartlanders are affected and so are their pet's health care treatment being delayed.
It is like my 8-year-old car. It cost me a bomb to repair the leaked radiator and yet after spending $6,000 over a period of one year, the radiator system still leaked. I had to rent cars while it was in the workshop. Recently, I scrapped it as the leak continued.
But this dog was drooling for the first time. What was the cause?
"If the dog does not drool till Christmas, it will be great," the owner said.
"Why not give him 2 weeks' chance?" I asked. "I give the medication and you stop feeding dog treats. Just canned food - no dry food and water for two weeks."
"Are you sure you can stop the drooling permanently?" the man asked.
"I don't know. If the gum ulcers heal and you don't feed abrasive food or treats, there may be a chance."
This was the live or die situation for this friendly big-sized Cocker Spaniel with white beard. At 13 kg, he was thin and he had a rectal temperature of 39.5C which might be a sign of fever. Due to economic reasons, I did not ask for a blood test to screen his health. I gave two injections and medication. "Strictly just canned food and water for the next 2 weeks." I said. "This is his last chance to live."
The next sunny blue sky morning of Tuesday, May 21, 2013 at 10 am, I phoned the gentleman. His sleepy voice over the phone told me that the dog had considerably reduced his drooling. "Last night, he did not drool at all. Maybe a drop or two! Wait, I will check him now."
He examined the dog and replied: "The drooling absolutely stopped. Will this be permanent?"
"Much depends on the cause of the gum ulreration," I said. This viscous salivation reminds me of cats being given some drugs they dislike and so they produce viscous salivation and drooling.
"Did you use alcoholic wipes to clean your dog's mouth?" I asked by the way.
"Yes, I do," he had bought some commercial wipes. "But there is no alcohol."
"Are those the baby backside wipes?" I asked.
"Yes," he said.
So, this follow up is useful in that the cause of salivation could be his habit of wiping the dog's mouth twice a day to clean him. The chemicals inside the wipe cause gum ulcers and evoked viscous salivation. There would be a smell of "bad breath."
"Do you think the wipes cause this drooling?" the man asked me.
"It is possible. Stop all wipes. Use paper towel or tissue paper."
I have to wait and see for 2 weeks. If there is no more drooling, this dog has a reprieve and may live up to 20 years of age. Much past his expiry date of 12 years according to the internet.
THE CASE FOR OR AGAINST EUTHANASIA -
THE DOG HAS LIVED PAST THE EXPIRY DATE
14-year-old.male Cocker Spaniel.
Profuse salivation and "bad breath" now.
"He keeps drooling and he has bad breath. Is it worth treating him?" the gentleman owner consulted me for the first time at 7.30 pm on Monday May 20, 2013, half hour before my closing time. ""I read from the internet that Cocker Spaniels live up to 12 years and he is already 14 years old."
"This Cocker Spaniel is active. Is he eating or not?" I wanted to confirm.
"He eats a lot," the man said.
"One of the main reasons Singaporean dog owners put an old sick dog to sleep is financial," I said.
"Oh, I can afford the fees. Is it value for money? Will there be more medical problems down the road if you treat this drooling?"
"The decision to euthanase has to be made by the owner," I replied. "If he is my dog, I will get him treated for drooling and bad breath." Actually, there was no loud stench. I reviewed the medical records as the dog had been treated by my associate vets in the past 2 years. In April 2012, my associate vet had operated on the right ear for aural haematoma, excised a big skin wart and did dental scaling under anaesthesia. The costs amounted to $751. In May 2012, the dog was hospitalised 7 days for a ruptured skin abscess, costing $315. So, in 2012, the owner had spent around $1000 whereas for the past 11 years of the dog's life, he did not have to pay for veterinary costs except for the $35 annual vaccination from 2009 - 2012. In April 2013, he paid around $744 for dental and removal of skin lumps. Now there is profuse salivation.
So, I can understand that he is worried that there will be more veterinary bills and since the Cocker Spaniel is expected to live for 12 years, his dog had exceeded the life expectancy. So, he asked me whether he ought to euthanase him. The cost of living had shot up incredibly high with car, rental and property prices too high as there seemed to be a group of rich consumers. Many heartlanders are affected and so are their pet's health care treatment being delayed.
It is like my 8-year-old car. It cost me a bomb to repair the leaked radiator and yet after spending $6,000 over a period of one year, the radiator system still leaked. I had to rent cars while it was in the workshop. Recently, I scrapped it as the leak continued.
But this dog was drooling for the first time. What was the cause?
"If the dog does not drool till Christmas, it will be great," the owner said.
"Why not give him 2 weeks' chance?" I asked. "I give the medication and you stop feeding dog treats. Just canned food - no dry food and water for two weeks."
"Are you sure you can stop the drooling permanently?" the man asked.
"I don't know. If the gum ulcers heal and you don't feed abrasive food or treats, there may be a chance."
This was the live or die situation for this friendly big-sized Cocker Spaniel with white beard. At 13 kg, he was thin and he had a rectal temperature of 39.5C which might be a sign of fever. Due to economic reasons, I did not ask for a blood test to screen his health. I gave two injections and medication. "Strictly just canned food and water for the next 2 weeks." I said. "This is his last chance to live."
The next sunny blue sky morning of Tuesday, May 21, 2013 at 10 am, I phoned the gentleman. His sleepy voice over the phone told me that the dog had considerably reduced his drooling. "Last night, he did not drool at all. Maybe a drop or two! Wait, I will check him now."
He examined the dog and replied: "The drooling absolutely stopped. Will this be permanent?"
"Much depends on the cause of the gum ulreration," I said. This viscous salivation reminds me of cats being given some drugs they dislike and so they produce viscous salivation and drooling.
"Did you use alcoholic wipes to clean your dog's mouth?" I asked by the way.
"Yes, I do," he had bought some commercial wipes. "But there is no alcohol."
"Are those the baby backside wipes?" I asked.
"Yes," he said.
So, this follow up is useful in that the cause of salivation could be his habit of wiping the dog's mouth twice a day to clean him. The chemicals inside the wipe cause gum ulcers and evoked viscous salivation. There would be a smell of "bad breath."
"Do you think the wipes cause this drooling?" the man asked me.
"It is possible. Stop all wipes. Use paper towel or tissue paper."
I have to wait and see for 2 weeks. If there is no more drooling, this dog has a reprieve and may live up to 20 years of age. Much past his expiry date of 12 years according to the internet.
Saturday, May 18, 2013
Update Yorkshire 16 hours after breast tumour surgery
Update & Review of breast tumours removed yesterday at 4 pm. Very weak not standing when the owner visited at 7 pm. On IV drip.
Saturday May 18, 2013 9.29 am. Alert, walking. Not eating. Some swelling at right MG 2.
CASE
Yorkshire Terrier, F, Not spayed. Mammary tumours x 4.
7 months ago, small nodules but not excised as owner was worried about anaesthesia.
Tumours in right & left MG5 are extensive.
To remove only the right chain, MG3,4,5 as there will be no skin to suture if the left MG5 is also removed with the right MG5. Ovariohysterectomy not done at same time as the dog is very old. Shorter the surgery, higher the chances of survival.
SURGERY. Dr Daniel Sing to operate and I to assist. Nai to do vet anaesthesia.
The surgery took around one hour at minimal anaesthesia isoflurane 0-3%. Dom + Ket at 50% of formula given IV. IV drip.
Blood test May 17, 2013
Only urea high at 10.7 (4.2-6.3) and creatinine low 39 (89-177), platelets very high 886 (200-500). umours have spread possibly via the blood stream --- high platelet counts?. No X-rays of lungs done owing to economic reasons.
Goes home today 10.15 am.
Saturday May 18, 2013 9.29 am. Alert, walking. Not eating. Some swelling at right MG 2.
CASE
Yorkshire Terrier, F, Not spayed. Mammary tumours x 4.
7 months ago, small nodules but not excised as owner was worried about anaesthesia.
Tumours in right & left MG5 are extensive.
To remove only the right chain, MG3,4,5 as there will be no skin to suture if the left MG5 is also removed with the right MG5. Ovariohysterectomy not done at same time as the dog is very old. Shorter the surgery, higher the chances of survival.
SURGERY. Dr Daniel Sing to operate and I to assist. Nai to do vet anaesthesia.
The surgery took around one hour at minimal anaesthesia isoflurane 0-3%. Dom + Ket at 50% of formula given IV. IV drip.
Blood test May 17, 2013
Only urea high at 10.7 (4.2-6.3) and creatinine low 39 (89-177), platelets very high 886 (200-500). umours have spread possibly via the blood stream --- high platelet counts?. No X-rays of lungs done owing to economic reasons.
Goes home today 10.15 am.
Friday, May 17, 2013
1423. Old female Maltese had bladder rupture and vomiting
The 13-year-old female Maltese had a much swollen abdomen. Tense. Bladder ruptured and contained green fluid. The wound was stitched up. Continued vomiting the next 2 days. Blood tests renal disorder and total WCC of 43 (7-17). The prognosis was poor. The family decided on euthanasia.
1422. The Yorkshire is too "light-weight" for surgery
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Thursday, May 16, 2013
1421. Intellectual property for a write/illustrator
Another client of mine had written 10 stories on core values for a pre-school operator. "He paid me very little as compared to another writer," she said to me. "My stories are better as I write, illustrate and translate to Chinese language."
"He asked you to sign and paid you," I said. "So he has the copyrights. But you can always write another version. After all, you can write about a cat with one black ear instead of two black ears." She had lost her motivation.
Core values are now in the school curriculum but she said there are many other authors. "Does it mean no new writers should write about the same topic just because there are thousands of writers of how to care for your cat?"
"He asked you to sign and paid you," I said. "So he has the copyrights. But you can always write another version. After all, you can write about a cat with one black ear instead of two black ears." She had lost her motivation.
Core values are now in the school curriculum but she said there are many other authors. "Does it mean no new writers should write about the same topic just because there are thousands of writers of how to care for your cat?"
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